Health economic evaluation in England

Area of Science:

• Health economics
• Public health policy
• Healthcare management

Background:

• The National Health Service (NHS) Constitution mandates health economic evaluations for decision-making.
• Agencies like NICE and the Joint Committee on Vaccinations and Immunisations utilize these evaluations.
• Existing methods are termed 'extra-welfarist', diverging from neoclassical economics.

Purpose of the Study:

• To analyze the methodologies and outcomes of health economic evaluations in England.
• To examine the impact of 'extra-welfarist' approaches on healthcare access.
• To investigate factors influencing technology adoption despite cost-effectiveness thresholds.

Main Methods:

• Analysis of health economic evaluation frameworks used by UK health bodies.
• Review of policies regarding benefit (QALYs) and cost valuation.
• Examination of changes in discounting policies and their implications.
• Investigation of special funding mechanisms and Patient Access Schemes.

Main Results:

• NICE's extra-welfarist methods, focusing on QALYs and healthcare costs, guide evaluations.
• Discounting policies have varied across agencies and over time.
• Special funding initiatives (e.g., Cancer Drugs Fund) and Patient Access Schemes have increased access.
• Few technologies are denied by the NHS in England solely on cost-effectiveness grounds.

Conclusions:

• The NHS in England demonstrates a high rate of technology adoption, with limited denials based on cost-effectiveness.
• Flexible mechanisms like Patient Access Schemes play a crucial role in enabling access to medicines.
• Ongoing debates around value-based pricing and alignment with neoclassical economics continue to shape evaluation methods.